1 Electrolytes

Sodium: Na+
Serum: 135-145 for adults Panic: <115

Function:

 MAJOR: maintain extracellular volume (fluid distribution)

 90% of DCF cations = Na+
 Low Na+ leads to a dilution of ECF which pushes water into cells
 High Na+ pulls water out of cells which leads to cellular dehydration
 Other functions: maintains body fluid osmolarity
 Neuromuscular responses (nerve/muscle impulses)
 Acid-Base balance regulation
 KIDNEYS regulate Na+ via ALDOSTERONE
 Cerebral cells are v. sensitive to NA

Hyponatremia: below 135

SX:

 Thirst and decreased urine output no sweat, hallucinations, convulsions,

 Concentrated urine (dark yellow) fatigue, coma
 Confusion, decreased  Increased heart rate
consciousness/restlessness, no tears,

TX:

 replace Na and fluid loss through diet or  When below 125, bring up the value
IV fluid quickly to 125 then let it increase slowly
to normal levels
 Isotonic saline, lactated ringers.

Hypernatremia: above 145

SX:

 irritability,  fever,
 sometimes interspersed with lethargy,  excessive dieresis,
 altered senses,  oligoanuria
 seizures,

 low skin turgor,  neuromuscular excitability,

 thirst,  seizure,
 confusion,  coma,
2 Electrolytes

 Tachycardia, (including orthostatic  confusion,

tachycardia.),  Poor capillary refill.
 hypotension,  volume depletion from fluid losses,
 Tachypnea,  Diuretic therapy, renal/adrenal disease.

TX:

 Gradually lower serum Na+ level to  Infusion of 0.9% NS or 0.45Na+D5W, or

decrease the risk of cerebral edema. diuretics.

Potassium (K+) Test: Serum: 3.5-5.5

Function:

 Water balance INSIDE cell  Release insulin from Islets of

 Convert glucose to glycogen Langerhans
 Store N in muscle CHON and energy  Lowers BP when high against Na+
production

Hypokalemia:

Below 3.5

Causes: alkalosis, GI, renal loss, high perspiration, poor dietary intake

SX:

 fatigue,  N&V,
 muscle weakness,  irritability,
 DIMINISHED DEEP TENDON  sensitivity to digitalis,
REFLEXES,  EKG changes
 anorexia,

TX:

Mild: dietary increase or oral supplements

Severe: (below 2.0) IV PB Never, never, never push K

Hyperkalemia: Above 5.5

Seldom w/normal renal function

Conditions that can cause: renal failure, burns, crush injuries, acidosis, diuretics

SX:
3 Electrolytes

 ECG changes,  Nausea

 Vague muscle weakness  Cramping
 Flaccid paralysis  Diarrhea
 Anxiety

TX:

 restrict dietary in mild cases incl.  IV bicarbonate (alkalize plasma and shift
discontinue supplements K to cells)
 IV Ca gluconate for cardio if necc,  Peritoneal dialysis

ECG: WIDENS QRS, prolongs PR and VENTRICULAR DYSRHYTHMIAS

Phosphorus (HPO4+) Test: Serum: 2.7-4.5

 Function:  Cellular building block – nucleic acids,

 Essential to all cells essential to cell membrane formation
 Role in metabolism of CHO, CHON,  O2 delivery, function in formation of RBC
Fats  Fyi: 80% HPO4 in body in teeth and
 Essential to energy (formation of ATP boons, 40% in ICF.
and ADP)

Hypophosphatemia

Below 2.7

From: malnutrition, some antacids, renal failure, hyperparathyroidism, hypercalcemia, ETOH w/drawl,
ketoacidosis, resp. alkalosis

SX:

 Confusion  Shallow respirations

 Seizures  Increased bleeding tendency
 Weakness  Bone pain
 Decreased deep tendon reflexes

TX: mild/moderate: PO supplements

Severe: IV

Hyperphosphatemia

Serum above 4.5

4 Electrolytes

From: dietary intake, overuse of laxatives/enemas, Vit. D intoxication, hypoparathyroidism, renal

insufficiency, chemo

SX:
 neuromuscular irritability, angle of jaw, usually twitch at mouth or
 muscle weakness, nose on same side of face)
 hyperactive reflexes,  or positive Trousseau’s sign (flexion at
 tetany, the wrist, flexion at the
 positive Chvostek’s (facial twitch when metacarpophalangeal joints, extension
stimulate facial nerve by tapping at of the interphalangeal joints, adduction
of the thumbs and fingers)


TX:
 Identify underlying pathology  Adm. Phosphate binding gels
 Restrict dietary intake

Magnesium (Mg2+)Test: Serum: 1.5-2.5

Function:
 Works with Ca, K, Na (they can’t work  Bone health and structure,
w/o Mg)  assists with glucose to energy
 Muscle control, transformation

Imbalance is rare because Mg is so commonly available

Hypermagesemia:
Associated with renal dysfunction or large quantities of antacids, laxatives or analgesics

SX:
 Flush,  hallucinations,
 lethargy,  bradycardia,
 sedation,  hypotension,
 decreased reflexes,  coma,
 shallow breathing,  cardiac arrest
 muscle weakness,

TX:

 Decrease PO Mg  Support respiratory function

 Adm. Ca gluconate (Mg antagonist)

Hypomagnesmia:

Associated with chronic ETOH, malabsortion, malnutrition, starvation, prolonged diarrhea, acute
pancreatitis, prolonged Mg free solution, prolonged nasogastric suctioning

SX:
 Hyperactive reflexes  Muscle Cramps
 Coarse tremors  Parathesia (legs)
5 Electrolytes

 Painfully cold hands and feet  Seizures

 Disorientation  Dysrhythmias

TX:

 PO Mg salts  1-2 g 0.10 Mg by IV push at 1.5ml/min

 5g MgS IV in D5W or D5WNS

Calcium (Ca2+)Normal Reference Value: 8.5 – 10.5

Functions:

 Skeletal elements, bone and teeth  MOST ABUNDANT ION IN SKELETAL

 Regulating neuromuscular activity SYSTEM (99% in bones and teeth)
 Enzyme activity  PTH (parathyroid hormone) responsible
 Prothrombin to thrombin (holds cells for transfer of Ca from bones to plasma.
together)

Functions:

 Bones and teeth  Neural transmissions

 Activate enzymes  Blood clotting

Reciprocal with Phosphate (an increase in Ca leads to a decrease in phosphorus, and an increase in
phosphorus leads to a decrease in calcium)

3 forms in plasma: 1. Ionized (50% total ca) 2. Bound (less than 50%) and 3. Complexed (small
portion that combines with phosphate).

Ionized Ca (affected by plasma pH, P, albumin): increase in pH decreases Ca ionized.

Hypocalcemia:Below 8.5

Can be caused by some loop diuretics, dilantin, Phenobarbital, antieoplastics, some radioactive
materials, corticosteroids, heparin, antacids.

SX:

 Numbness in fingers,  seizures,

 muscle cramps (esp. extremities),  long QT,
 irritability,  altered cardio,
 memory impairment,  possible CHF,
 delusions,  lowered cardio work values.
 positive Trousseau’s and Chvostek’s  Most dangerous sx: laryngospasm
sign, and tetany-like contractions.
 hyperactive deep tendon reflexes,
6 Electrolytes

TX: treat pathology.

Adm. Calcium gluconate (PO preferred) or IV

Hypercalcemia Above 10.5

Underlying pathologies: hyperparathyroidism, Paget’s disease, fractures, over use of calcium

containing antacids, some tumors. Some meds: megadoses of vit. A or D, thiamine diuretics, etc.

SX:

 Muscle weakness  Constipation

 In coordination  N&V
 Lethargy  Anorexia
 Deep bone pain  Polyuria/polydipsia
 Flank pain  Renal colic
 Pathologic fractions  Caution with digitalis, can precipitate
dysrrythmias.

TX:

 Treat underlying pathology  Cacitonin, 4-8U/kg, IM or subq q6-12h

 Adm. Saline dieresis. (0.45 Na, 0.9Na)  Bisphosphonates to inhibit bone
 Inorganic phosphates (PO or enema) reabsorption
 Hemodialysis PRN  Adm. Plicamycin (mithramycin) – inhibits
 Furosemide 20-40 mg q2 to prevent bone reabsorption
volume overload during Na adm.

Chloride (Cl-) Value: 98-108

Function:

Reg. serum osmolarity

Reg. fluid balance (w/Na)

Control gastric acidity

Reg. acid base balance

Chloride Shift: oxygen-carbon dioxide exchange

Major anion in ECF, reciprocal w/HCO3 (bicarbonate)

Hypocholoremia (below 98)

Mainly GI losses, usu. Vomiting/diarrhea, or pyloric obstruction, acute infection, chlorothiazide

diuretics, prolonged use D5W.
7 Electrolytes

SX:

 Tetany  Depressed respiration

 Hypertonic reflexes  Alkalosis

A deficiency in CL reflects deficiency in K. When replacing K use KCl, when serum drops to 80 or
lower, sever mentation, hypotension and Cardio dysrhythmias.

TX:

 Treat pathology  Hyperchloremia

 Adm. NaCl solution

From: head injury and other trauma causing retention of Na and Cl. Hormones, severe dehydration,
acidosis.

SX

 Drowsiness  Tachypnea
 Lethargy  Kussmaul respiration
 HA  Hyperventilation
 Weakness  Dysrrythmias
 Tremors  Cardiac dysrrythmias
 Dyspnea,

TX:

Treat underlying disorder